South Portland Psychologist Pleads Guilty to Health Care Fraud
|U.S. Attorney’s Office May 21, 2013|
PORTLAND, ME—United States Attorney Thomas E. Delahanty, II announced that Dr. Carole Orem-Hough, Ph.D., age 55, of South Portland, pled guilty in the U.S. District Court in Portland before Judge George Z. Singal to committing health care fraud.
According to court records, from September 2008 to September 2011, Orem-Hough was a licensed psychologist doing business as Casco Bay Psychotherapy in South Portland. During that time, she provided counseling services to patients, many of whom were insured by private health insurance plans. Orem-Hough admitted that she defrauded Aetna, Anthem Blue Cross and Blue Shield, Harvard Pilgrim, and OptumHealth Behavioral Solutions by submitting claims for counseling sessions that never occurred. In many cases, Orem-Hough billed insurance companies for two counseling sessions per week when Orem-Hough only saw the patient once per week. Orem-Hough told one patient that she double-billed Aetna because the company reimbursed her about half of what she received from other companies.
U.S. Attorney Delahanty stated that the fraud loss in this case is over $69,000 and involved false claims with respect to almost 50 patients. Orem-Hough faces up to 10 years in prison and a fine of up to $250,000. She will be sentenced after completion of a pre-sentence investigation report by the U.S. Probation Office.
This case was investigated by the Federal Bureau of Investigation after a patient noticed and reported billing discrepancies in an Explanation of Medical Benefit Statement from the patient’s health insurance company.